Provider Demographics
NPI:1245623446
Name:DR KEITH WEIN DC PSC
Entity type:Organization
Organization Name:DR KEITH WEIN DC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-376-9562
Mailing Address - Street 1:2328 REDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1280
Mailing Address - Country:US
Mailing Address - Phone:502-376-9562
Mailing Address - Fax:
Practice Address - Street 1:2030 IN-337
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112
Practice Address - Country:US
Practice Address - Phone:812-738-1935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR KEITH WEIN DC PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000999A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300064741Medicaid